New posts for coin-operated doctors and nurses. According to the new guidelines published in Official Journal, adopted in implementation of what was already provided for in the law of 26 May for the assignment of services to third parties, the call for doctors and nurses may only take place out of necessity and urgency, on a single occasion and without the possibility of extension, in the event that it is not possible to overcome the shortages of healthcare personnel.
New rules for coin-operated doctors and nurses
The use of paid professionals exploded during the period pandemicis now strictly regulated. These provisions are part of the broader context of the law of 26 May, which regulates the entrusting of healthcare services to third parties.
The new guidelines limit the use of token operators only to cases of extreme necessity and urgency, with precise hourly rates and without the possibility of extensions. The main objective is to contain costs and guarantee greater stability of healthcare personnel.
In particular, a maximum limit on compensation for token operators is established: doctors will be able to receive up to 85 euros per hour for first aid and resuscitation up to 75 euros for other medical services, while for nurses the maximum rate is 28 euros per hour in the emergency room and 25 euros for other services.
Token doctors in Italy
It is not possible to precisely quantify the number of doctors who work for a fee in Italy, due to the lack of clear regulation of the phenomenon. However, the dramatic increase in resignations of doctors of non-retirement age, estimated at 8,500 in the last four yearscould be an indirect indicator of this trend.
According to a Cimo survey dating back to two years ago, almost 38% of the doctors interviewed expressed the intention to leave the public sector, attracted by more remunerative and less stressful job offers in the private sector.
The phenomenon of ‘tokenist’ doctors seems to be particularly widespread in Northern Italyconcentrating above all in small and medium-sized hospitals, which are less attractive than large urban centres. A report from Court of Auditors found a 47% increase in temporary collaborations in the healthcare sector in recent years, a figure that reflects the increase in the use of token doctors.
“There are regions that issue tenders in which they plan the management of emergency rooms with paid doctors for the next two or three years: it is clear that the use of these doctors has now become the norm,” he declared to Post Giuseppe Milanesepresident of Confcooperative Sanità. There Lombardy it was among the regions that attempted to stem the phenomenon of token doctors, issuing a resolution in 2023 that prohibited their use in public facilities. However, a TAR ruling partially suspended this measure, following an appeal by some private companies.
An important turning point came this summer with the announcement by the Minister of Health Orazio Schillaci of the abolition of spending ceiling for medical staff starting from 2025. Introduced in 2004, this limit has always hindered the hiring of new professionals, contributing to the increase in the use of external figures such as token doctors.
